Depression and Burnout among Health Extension Workers in Ethiopia: A Cross-Sectional Study

BACKGROUND: Depression and burnout are common among healthcare workers (HCWs) and negatively affect their well being and the quality of the service they provide. However, the burden of depression and burnout among health extension workers (HEWs) in Ethiopia and their relationship has not been documented well. The objective of this study was to estimate the prevalence of depression and burnout among HEWs in Ethiopia and to investigate the relationship between these conditions. MATERIALS AND METHODS: We used a cross-sectional study design and collected data from 584 rural and 581 urban HEWs in Ethiopia, as part of the 2019 national health extension program assessment. The Patient Health Questionnaire (PHQ-9) and Burnout Self-Test were used to screen HEWs for depression and burnout, respectively. We used descriptive statistics to estimate the magnitude of depression and burnout, and logistic regression to examine their relationship. RESULT: Based on PHQ-9 cutoff scores of 10, the prevalence of major depression was 16.5% among rural and 8.9% among urban HEWs, whereas burnout risk was 39.8% among rural and 12.6% among urban HEWs. The odds of having depression among HEWs with burnout risk was relatively higher compared to those without burnout risk [For rural HEWs, the adjusted odds ratio (AOR) is 11.88 at a 95% confidence interval (CI; 5.27, 26.80), and for urban HEWs, the AOR is 11.49 at a 95% CI (5.35, 24.63)]. CONCLUSION: The prevalence of depression and burnout is high among HEWs in Ethiopia, with a significant rural­urban difference, and burnout is a significant predictor of depression. Mental health interventions that enable prevention, early detection, and management are needed especially for rural HEWs who are in charge of preventive health service delivery for the disadvantaged rural communities

Self-medication among inhabitants of Yaounde, Cameroon: Pull and push factors

The rampant practice of self-medication is indicative of very strong existing push and pulls factors. These factors could be economic, social or systemic. Despite having some beneficial effects, selfmedication has life-threatening consequences. This study was aimed to determine the factors which push users to medicine sources or factors at the sources which pull users. A pre-validated questionnaire was administered to participants. Data were collected and analyzed using Microsoft Excel and the results expressed as frequencies and percentages. From the total of 650 respondents, poverty was found to be the major push factor for 360 participants (55.39%), followed by unprofessionalism, friends' advice, previous use of medicine, lack of time, and poor price regulation as others. Low cost of medicines was found to pull 402 (61.8%) users to sources of medicines for self-medication. More than 300 of the respondents found easy access to medicine and advertising as strong pull factors. Other important pull factors include quick and time-saving, proliferation of medicine vendors, hospital crowds, and inadequate prescription checks at sources of medication. Poverty is a major push factor for self-medication, further compounded by quick access to illicit sources of medication. Consequently, users get pulled to cheaper sources, which unfortunately sell poor quality medicines, lack the expertise, or do not check prescription. Price control is required to ensure that quality medicines are accessible to users. Imposing physician prescription at all medicine sales points is a crucial step to fight the deleterious consequences of self-medication. Although self-medication has some positive elements, its practice needs to be put under control to avoid grappling with long term health complications.

Gender-based violence during COVID-19 lockdown: case study of a community in Lagos, Nigeria

Background: Gender-based violence (GBV) has been identified to be one of the ripple effects of the global pandemic. In countries like Nigeria, the situation is hypothesized to be worse because of widespread poverty and gender inequalities. Objective: To examine the exposure of females to GBV during the first 3 months of the COVID-19 lockdown. Method: This cross-sectional study was conducted in a low-income community in Lagos. Semi-structured questionnaires were administered to 130 respondents selected via systematic random sampling. Results: The mean age of the respondents was 26.89 ± 8.67 years. Majority worked informal jobs, while only 50% had attained beyond primary education. Within the period, the respondents had been subjected to sexual (54.6%), physical (52.3%), verbal assault (41.5%), and online sexual harassment (45.4%); of which only 30% reported to the police. Furthermore, respondents subjected to sexual (p=0.004) and physical assault (p=0.032) during the period earned significantly less money than other respondents. Conclusion: The fact that over 1 out of every 2 females was subjected to at least one form of GBV within the short timeframe shows how unsafe girls and women in low-income communities are. This calls for proactive community-level interventions to curb the GBV menace.

Socio-cultural factors influencing teenage pregnancy in the East Mamprusi Municipality, Ghana

Teenage pregnancy puts a heavy cost on the mother and newborn child, family and the wider society. Despite measures taken by the Ghana Health Service to tackle the issue of teenage pregnancy, the phenomenon remains a public health concern that is widespread throughout the country. The study investigated the socio-cultural factors influencing teenage pregnancy in the East Mamprusi Municipality using an exploratory descriptive design. The study was conducted in rural communities in the East Mamprusi Municipality, in the North East Region of Ghana. Eighteen (18) participants were purposively sampled. Data collection was done by face to face interviews using an interview guide. The study found that polygamous families, parents' desire for grandchildren, multiple sexual partners and poverty were reportedly influencing teenage pregnancy in the rural community. The bid to establish close family ties also accounted for early marriages. There is a culture of silence on matters of sexuality in the community. Teenage pregnancy is an observed phenomenon admitted by the participants and teenage girls are at risk of serious health complications. This phenomenon paints a gloomy picture of the girl child education in the municipality. (Afr J Reprod Health 2022; 26[5]: 120-130).

Catastrophic Health Expenditure and Impoverishment from NonCommunicable Diseases: A comparison of Private and Public Health Facilities in Ekiti State, Southwest Nigeria

Catastrophic health expenditure and impoverishment are the outcomes of poor financing mechanisms. Little is known about the prevalence and predictors of these outcomes among non-communicable disease patients in private and public health facilities. METHODS: A health facility-based comparative cross-sectional study was conducted among 360 patients with non-communicable diseases (180 per group) selected through multistage sampling. Data were collected with a semi-structured, interviewer administered questionnaire and analyzed with IBM SPSS for Windows, Version 22.0. Two prevalences of catastrophic health expenditure were calculated utilizing both the World Bank (CHE1) and the WHO (CHE2) methodological thresholds. RESULTS: The prevalence of CHE1 (Private:42.2%, Public:21.7%, p<0.001) and CHE2 (Private:46.8%, Public:28.0%, p<0.001) were higher in private health facilities. However, there was no significant difference between the proportion of impoverishment (Private: 24.3%, Public:30.9%, p=0.170). The identified predictors were occupation, number of complications and clinic visits for catastrophic health expenditure and socioeconomic status for impoverishment in private health facilities. Level of education, occupation, socioeconomic status, number of complications and alcohol predicted catastrophic health expenditure while the level of education, socioeconomic status andthe number of admissions predicted impoverishment in public health facilities. CONCLUSION: Catastrophic health expenditure and impoverishment were high among the patients, with the former more prevalent in private health facilities. Therefore, we recommend expanding the coverage and scope of national health insurance among these patients to provide them with financial risk protection. Identified predictors should be taken into account by the government and other stakeholders when designing policies to limit catastrophic health expenditure and impoverishment among them

The impact of an inclusive education intervention on learning outcomes for girls with disabilities within a resource-poor setting

Background: Despite a global commitment to the right to education for persons with disabilities, little is known about how to achieve inclusive education in practice, particularly in low- and middle-income countries (LMICs), where the majority of the world's people with disabilities reside. Moreover, although exclusion from education is magnified by intersecting gender and socioeconomic inequalities, there is especially little knowledge regarding what approaches to inclusive education are effective amongst girls with disabilities living in resource-poor settings. Objectives: The objective of this article was to assess the impact of an inclusive education intervention led by a non-governmental organisation (NGO) on the educational attainment of girls with disabilities in the resource-poor Lakes region of Kenya. Method: A quasi-experimental design was employed, where the literacy and numeracy educational attainment of the intervention and control groups was compared over two time points a year apart (Time 1 and Time 2; total matched N = 353). During this period, activities pertaining to six core components of a holistic inclusive education model were implemented. Results: Relative to the control group, girls with disabilities in the intervention group reported a greater increase in literacy and numeracy attainment, adjusted for grade and level of functional difficulty. Conclusion: Findings suggest that the intervention was successful in engendering additional improvements in the educational attainment of girls with disabilities from the resource-poor Lakes region of Kenya. Results highlight both the applicability of NGO-led interventions in settings, where national implementation of inclusive education is constrained, and the potential of taking such interventions to scale

Prevalence and causes of visual impairment among older persons living in low-income old age homes in Durban, South Africa

Background: Visual impairment (VI) increases with age and has been reported to be more prevalent among older adults living in old age homes than in the general population. Aim: To determine the prevalence and causes of VI among older adults living in low-income old age homes in Durban, South Africa. Setting: This study was conducted at low-income old age homes in Durban. Methods: This cross-sectional study of 118 residents aged 60 years and older, collected socio-demographic data, presenting visual acuities (VAs) for each eye, and binocularly. Anterior segment eye examinations were conducted with a penlight torch and a portable slit-lamp, while posterior segment evaluation was conducted with direct and indirect ophthalmoscopy. Objective and subjective refractions were performed, and the best-corrected distance and near VAs were measured in each eye. VI was defined as presenting VA < 6/18 and included moderate VI (< 6/18−6/60), severe VI (< 6/60 ­3/60) and blindness (< 6/120). Results: The mean age of the participants was 73.3 years and included 80.5% females and 19.5% males. The prevalence of VI and blindness was 63.6%. Optical correction significantly reduced the prevalence of VI and blindness by 19.5% (p < 0.05). The main causes of non-refractive VI and blindness were cataract (54.5%), posterior segment disorders (25.5%) and corneal opacities (20%). Conclusion: The prevalence of VI and blindness is high among residents in low-income old age homes living in Durban. Refractive correction and surgical cataract intervention can significantly reduce the burden of VI and blindness among the elderly residents

Cost and consequence analysis of the Healthy Choices at Work programme to prevent non-communicable diseases in a commercial power plant, South Africa

Background: The workplace is an ideal setting for the implementation of a health promotion programmes to prevent non-communicable diseases (NCD). There are limited resources assigned to workplace health promotion programmes in low-and middle-income countries (LMIC). Aim: This study aimed to conduct a cost and consequence analysis of the Healthy Choices at Work programme. Setting: This study was conducted at a commercial power plant in South Africa. Methods: Incremental costs were obtained for the activities of the Healthy Choices at Work programme over a two-year period. A total of 156 employees were evaluated in the intervention, although the effect was experienced by all employees. An annual health risk factor assessment at baseline and follow up evaluated the consequences of the programme. Results: The total incremental costs over the two-year period accumulated to $4015 for 1743 employees. The cost per employee on an annual basis was $1.15 and was associated with a −10.2mmHg decrease in systolic blood pressure, −3.87mmHg in diastolic blood pressure, −0.45mmol/l in total cholesterol and significant improvement in harmful alcohol use, fruit and vegetable intake and physical inactivity (p < 0.001). There was no correlation between sickness absenteeism and risk factors for NCDs. Conclusion: The cost to implement the multicomponent HCW programme was low with significant beneficial consequences in transforming the workplace environment and reducing risks factors for NCDs. Findings of this study will be useful for small, medium and large organisations, the national department of health, and similar settings in LMICs

Rwandan primary healthcare providers' perception of their capability in the diagnostic practice

Background: Skill-mix imbalance is a global concern for primary healthcare in low-income countries. In Rwanda, primary healthcare facilities (health centres, HCs) are predominantly led by nurses. They have to diagnose a multitude of health complaints. Whether they feel capable of undertaking this responsibility has yet to be explored. Aim: This study explored how healthcare providers (HPs) at Rwandan HCs perceived their capability in the diagnostic practice. Setting: Rural and urban HCs in Muhanga district, Rwanda. Method: Qualitative, semi-structured interviews with nurses and clinical officers, and observations of consultations were made. Findings were analysed thematically. Results: Rwandan HPs were confident in their competences to perform diagnostic procedures although nurses felt that the responsibilities lay beyond their professional training. Clinical officers believed that their professional training prepared them to function competently and autonomously in the diagnostic practice, although all HPs experienced a high dependency on medical history taking, physical examination and laboratory tests for reaching a diagnosis. Resource constraints (time, rooms and laboratory tests) were seen as a barrier to perform diagnostic tasks optimally, and HPs experienced in-service training and supervision as insufficient. They increased their diagnostic competences through work experience, self-learning and supportive peer collaboration. Conclusion: Clinical officers perceived themselves as capable in the diagnostic practice. Nurses may compensate for insufficient school training through in-service learning opportunities and feel capable in the diagnostic practice. Formative mentorship schemes and tailored education may prove valuable, but further research on how to improve HPs' diagnostic capability in Rwanda's primary healthcare sector is needed

Figuring it out by yourself: Perceptions of home-based care of stroke survivors, family caregivers and community health workers in a low-resourced setting, South Africa

Background: In less resourced settings, formal rehabilitation services for stroke survivors were often absent. Stroke survivors were referred to community health workers (CHWs) who were untrained in rehabilitation. Aim: To describe the experience and perceived needs of stroke survivors, their caregivers and CHWs in a context with limited access to and support from formal rehabilitation services. Setting: The Breede Valley subdistrict, Western Cape, South Africa, a rural, less resourced setting. Methods: A descriptive exploratory qualitative study. Four focus group interviews were held with purposively selected stroke survivors and caregivers and four with CHWs. A thematic approach and the framework method were used to analyse the transcripts. Findings: A total of 41 CHWs, 21 caregivers and 26 stroke survivors participated. Four main themes and 11 sub-themes were identified. Because of the lack of knowledge, training and rehabilitation services, the main theme for all groups was having to 'figure things out' independently, with incontinence management being particularly challenging. Secondly was the need for emotional support for stroke survivors and caregivers. Thirdly, contextual factors such as architectural barriers and lack of assistive products negatively impacted care and function. Lastly, the organisation of health and rehabilitation services negatively impacted home-based services and professional support. Conclusions: With appropriate training, the CHWs can be pivotal in the training and support of family caregivers and stroke survivors. Care pathways and the role and scope of both CHWs and therapists in home-based stroke rehabilitation should be defined and restructured, including the links with formal services

Impact of traffic, poverty and facility ownership on travel time to emergency care in Nairobi, Kenya

Background: In many low and middle-income countries (LMICs), timely access to emergency healthcare services is limited. In urban settings, traffic can have a significant impact on travel time, leading to life-threatening delays for time-sensitive injuries and medical emergencies. In this study, we examined travel times to hospitals in Nairobi, Kenya, one of the largest and most congested cities in the developing world. Methods: We used a network approach to estimate average minimum travel times to different types of hospitals (e.g. ownership and level of care) in Nairobi under both congested and uncongested traffic conditions. We also examined the correlation between travel time and socioeconomic status. Results: We estimate the average minimum travel time during uncongested traffic conditions to any level 4 health facility (primary hospitals) or above in Nairobi to be 4.5 min (IQR 2.5­6.1). Traffic added an average of 9.0 min (a 200% increase). In uncongested conditions, we estimate an average travel time of 7.9 min (IQR 5.1­10.4) to level 5 facilities (secondary hospitals) and 11.6 min (IQR 8.5­14.2) to Kenyatta National Hospital, the only level 6 facility (tertiary hospital) in the country. Traffic congestion added an average of 13.1 and 16.0 min (166% and 138% increase) to travel times to level 5 and level 6 facilities, respectively. For individuals living below the poverty line, we estimate that preferential use of public or faith-based facilities could increase travel time by as much as 65%. Conclusion: Average travel times to health facilities capable of providing emergency care in Nairobi are quite low, but traffic congestion double or triple estimated travel times. Furthermore, we estimate significant disparities in timely access to care for those individuals living under the poverty line who preferentially seek care in public or faith-based facilities

Building focused cardiac ultrasound capacity in a lower middle-income country: a single centre study to assess training impact

Background: In low- and middle-income countries (LMICs) where echocardiography experts are in short supply, training non-cardiologists to perform Focused Cardiac Ultrasound (FoCUS) could minimise diagnostic delays in time-critical emergencies. Despite advocacy for FoCUS training however, opportunities in LMICs are limited, and the impact of existing curricula uncertain. The aim of this study was to assess the impact of FoCUS training based on the Focus Assessed Transthoracic Echocardiography (FATE) curriculum. Our primary objective was to assess knowledge gain. Secondary objectives were to evaluate novice FoCUS image quality, assess inter-rater agree-ment between expert and novice FoCUS and identify barriers to the establishment of a FoCUS training pro-gramme locally. Methods: This was a pre-post quasi-experimental study at a tertiary hospital in Nairobi, Kenya. Twelve novices without prior echocardiography training underwent FATE training, and their knowledge and skills were as-sessed. Pre- and post-test scores were compared using the Wilcoxon signed-rank test to establish whether the median of the difference was different than zero. Inter-rater agreement between expert and novice scans was assessed, with a Cohen's kappa > 0.6 indicative of good inter-rater agreement. Results: Knowledge gain was 37.7%, with a statistically significant difference between pre-and post-test scores (z = 2.934, p = 0.001). Specificity of novice FoCUS was higher than sensitivity, with substantial agreement between novice and expert scans for most FoCUS target conditions. Overall, 65.4% of novice images were of poor quality. Post-workshop supervised practice was limited due to scheduling difficulties. Conclusions: Although knowledge gain is high following a brief training in FoCUS, image quality is poor and sensitivity low without adequate supervised practice. Substantial agreement between novice and expert scans occurs even with insufficient practice when the prevalence of pathology is low. Supervised FoCUS practice is challenging to achieve in a real-world setting in LMICs, undermining the effectiveness of training initiatives

Spatial analysis of child mortality and welfare differentials in South Africa: evidences from the 2011 Census

Background: Welfare differential is a common phenomenon among South African population which can be manifested in terms of various economic and health outcomes. Using child mortality (CM) as one of a key measure of the country's health system, the study attempted to show its spatial distribution and the association with economic disparities in the country.Methods: The study primarily aimed to derive estimates of CM rates for the municipalities and provinces of South Africa and assessed the results in relation to some welfare measures such as poverty and inequality. The estimation of CM rates was achieved through the use of direct synthetic cohort methods with Bayesian spatial smoothing. The smoothing process helped to generate accurate municipal level estimates of CM. The model utilized information from neighboring municipalities by controlling the effects of women's education and HIV. Results: It was found that there were clear spatial differentials of CM in the country, where at province level under-five mortality (U5M) rate (deaths per 1000 live births) ranges from 26 in Western Cape to 71 in KwaZulu-Natal. At municipal level, it ranges from 24 in City of Cape Town to 109 in uPhongolo. It was also shown that CM was higher in poorer and more unequal areas, although there were cases which had inverse relationship. For instance, several municipalities in Limpopo province scored relatively lower child mortality rates though the level of poverty is very high Conclusions: The study revealed significant spatial differentials of CM in the country, which were also associated with the level of poverty and income inequality. The findings may help local and national government to implement policies more effectively and make more focused decisions for a better health outcome

The negative impact of poverty on the health of women and children

This article is based on "The Negative Impact of Poverty on the Health of Women and Children" and discusses the association between poverty and poor health. Poverty is high on the international development agenda. World conferences and summits have paid attention to the increasing levels of poverty of billions of the world's peoples. The poor die in young age and they usually suffer from communicable diseases, maternal and perinatal conditions, and nutritional deficiencies. They are not only at risk from diseases of the poor but they also suffer from lifestyle health problems that are often found among affluent communities. Unfortunately, in many communities, the most affected are women and children

Management of acute seizures in children: a review with special consideration of care in resource-limited settings

Introduction:We sought to review recent evidence-based guidelines and where applicable, primary data to ex-trapolate insights into the appropriate management of acute seizures in children in resource-limited settings.Methods:PubMed and Google scholar searches were conducted with attention to publications from the last three to five years, including a focused search for acute seizure management guidelines relevant to resource limited settings. Since all guidelines to date, except the World Health Organization's, assume ready access to invasive ventilation and advanced diagnostic testing, guidelines and primary data were used to propose managementappropriate for resource-limited settings where respiratory suppression from treatment presents a major challenge in management.Results:Acute seizures are among the commonest medical emergencies encountered in the African settings.Seizure management must occur simultaneously with the diagnostic assessment, which should include addres-sing life threatening causes (e.g. hypoglycaemia, malaria) and with attention given to the most likely aetiology ina particular region or setting. For ongoing seizures, initial treatment with benzodiazepines is indicated. There is evidence of efficacy for several agents and delivery modes. Longer-acting antiepileptic drugs (AEDs) should beon hand if acute seizures fail to respond to two doses of benzodiazepines. There is little direct evidence comparing the relative efficacy of different long-acting AEDs for acute seizure management in African children.Findings suggest that generalising data from Western settings, where different aetiologies and risk factors for seizures prevail, may be inappropriate.Discussion: Though treatment options and diagnostics may be dictated by available medications andcapacity, it is possible for virtually any healthcare setting to develop a relevant and feasible local guideline for seizure management. Clear specifications on when to refer to a higher level of care should be part of the care plan

Assessing the impact of an emergency trauma course for senior medical students in Kenya

Introduction:Ninety percent of all injury-related deaths occur in low- and middle-income countries. The WHO recommends short, resource-specific trauma courses for healthcare providers.Studies show that teaching trauma courses to medical students in developed countries leads to significant increases in knowledge and skill. High costs hinder widespread and sustained teaching of these courses in low-income countries.Methods:A two-day trauma course was designed for students at Moi College of Health Sciences in Eldoret,Kenya. Participants underwent pre- and post-course written and simulation testing and rated their confidence in 21 clinical scenarios and 15 procedures pre- and post-course using a five point Likert scale. A subset of the students was re-evaluated nine months post-course. Using the pairedt-test, mean written, simulation and confidence scores were compared pre-course,immediately post-course and nine months post-course.Results:Twenty-two students were enrolled. Written test score means were 61.5% pre-course and 76.9%post-course, mean difference 15.5% (p < 0.001). Simulation test score means were 36.7% pre-course and 82.2% post-course, mean difference 45.5% (p < 0.001). Aggregate confidence scores were 3.21 pre-course and 4.72 post-course (scale 1­5). Ten out of 22 (45.5%) students were re-evaluated nine months post- course. Results showed written test score mean of 75%, simulation score mean of 61.7%, and aggregate confidence score of 4.59 (scale 1­5). Mean differences between immediate post- and nine months post-course were 1.6% (p = 0.75) and 8.7% (p = 0.10) for the written and simulation tests, respectively.Conclusion: Senior Kenyan medical students demonstrated statistically significant increases in knowledge, skills and confidence after participating in a novel student trauma course. Nine months post-course, improvements in knowledge skills and confidence were sustained

Facteurs associés à la qualité de la pratique de l'allaitement maternel chez les mères d'enfants de 0-24 mois à Klouekanme, au sud-est du Bénin

Introduction : La malnutrition chez les enfants est un problème de santé publique, particulièrement en Afrique de l'ouest et du centre, où environ 56% des décès des enfants pourraient être évités si ces enfants n'étaient pas malnutris. Au Bénin, bien qu'environ 94% des enfants de 0-24 mois soient allaités au sein, la pratique de façon exclusive jusqu'à 6 mois est plus faible, avec 34% des enfants concernés.La présente étude avait pour objectif d'étudier les facteurs associés à une bonne pratique de l'allaitement maternel chez les mères d'enfants de 0-24 mois dans la commune de Klouékanmè au Sud - Est du Bénin.Méthodes : Il s'agissait d'une étude transversale, à visée descriptive et analytique. Elle a été réalisée dans des ménages ayant au moins un enfant de 0-24 mois. Les données ont été collectées en 2016 auprès des mères volontaires et présentes le jour de l'enquête. L'adéquation des pratiques actuelles d'allaitement maternel a été appréciée à l'aide d'un score de pratique de l'allaitement maternel créé sur la base des réponses obtenues pour les variables indicatrices de la pratique d'allaitement du jeune enfant. Le test de chi2 a été utilisé pour rechercher les associations entre les variables explicatives et la pratique adéquate de l'allaitement maternel. Le seuil de significativité a été fixé à p<0,05.Résultats : Au total, 204 couples mère-enfant ont été inclus dans l'étude. Près de 85% des enfants de 0-24 mois était sous allaitement maternel la veille de l'enquête. L'analyse de la qualité des pratiques d'allaitement maternel révèle que 45% des enfants, quel que soit leur âge, ont été allaités de façon adéquate. La qualité de la pratique d'allaitement a été la moins adéquate dans le groupe des mères qui avait une faible connaissance de la "composition de l'alimentation de l'enfant 6 à 9 mois" (p=0,010). La pratique d'allaitement maternel était très inadéquate parmi les mères ayant des enfants de 0-6 mois et 18-24 mois. Les mères ayant une pratique peu adéquate proviennent de ménages à faible effectif (p=0,035). De même, les mères les plus jeunes de l'étude (15-25 ans) ont majoritairement une pratique peu adéquate en matière d'allaitement maternel (p=0,004). Par contre l'âge des enfants (p<0,0001) et le rang de naissance (p=0,023) étaient significativement associés à la qualité de la pratique d'allaitement. Conclusion : Les résultats de l'enquête auprès des mères de Klouékanmè révèlent qu'au niveau communautaire, il existe encore des pratiques alimentaires inadéquates (type d'aliments, fréquences,texture, quantité et diversité). L'âge des enfants étant significativement associé à la qualité des pratiques d'allaitement jusqu'à l'âge de 24 mois, les interventions devront être adéquatement structurées afin de fournir l'appui nécessaire à la mère et ce à chaque stade de la croissance de son enfant

Le cancer de la verge à propos de deux cas. Pathologie rare : les difficultés de la prise en charge

Introduction : Le cancer de la verge est une prolifération maligne des cellules formant les tissus du pénis. C'est une pathologie rare. Le pronostic est favorable si le traitement est précoce. Notre but était de rapporter les deux cas de cette pathologie, en informant sur son épidémiologie, surtout les difficultés sur sa prise en charge. Patients et méthodes : C'est une étude de cas clinique sur deux patients présentant un cancer du pénis dans le service d'urologie du Centre Hospitalier Universitaire Joseph Ravoahangy Andrianavalona d'Antananarivo, Madagascar. Les paramètres étudiés sont la prévalence et la prise en charge de cette pathologie. Résultats : Nous avons observé une diminution de la prévalence. La difficulté de la prise en charge est causée par la pauvreté. Conclusion : Malgré la rareté de cette pathologie, sa prise en charge est encore difficile dans notre pays. La difficulté est due à la pauvreté

Development process in Africa: poverty, politics and indigenous knowledge

Background: Persons with disability run the danger of not profiting from the development process due to exclusion from basic services and opportunities. Still, the knowledge base on exclusion mechanisms is relatively weak and there is a danger that important aspects are not addressed as they are hidden behind established understandings that are not critically scrutinised. Objectives: The main purpose of this article was to highlight critical thoughts on prevailing knowledge of the relationship between disability and poverty, the policy base for addressing the rights of persons with disability; and culture as a key component in continued discrimination. Method: This article aimed at integrating three papers on the above topics presented at the 2011 African Network for Evidence-to-Action on Disability (AfriNEAD) Symposium. The researchers have therefore thoroughly examined and questioned the relationship between disability and poverty, the influence of policy on action, and the role of culture in reproducing injustice. Results: The article firstly claims that there are limitations in current data collection practice with regards to analysing the relationship between poverty and disability. Secondly, ambitions regarding inclusion of persons with disability in policy processes as well as in implementation of policies are not necessarily implemented in an optimal way. Thirdly, negative aspects of culture in discrimination and bad treatment of disabled need to be highlighted to balance the discussion on disability and culture. Conclusion: A critical view of prevailing understandings of disability and development is key to producing the knowledge necessary to eradicate poverty amongst persons with disability and other vulnerable groups. Not only do we need research that is actually designed to reveal the mechanisms behind the disability-poverty relationship, we need research that is less tied up with broad political agreements that is not necessarily reflecting the realities at ground level

The Effects of Household Assets Inequality and Conflict on Population Health in Sudan

We explored the effects on health of both household asset inequality and political armed conflict in Sudan. Using the 2010 Sudan household survey; we evaluated the role of both household asset distribution (measured by the Gini coefficient) and armed conflict status at the state level. We measured associations with six health-related outcomes: life expectancy; infant mortality; height-for-age (stunting); adequacy of food consumption; teenage birth rates and vaccination coverage for young children. For each of six measures of health in Sudan; outcomes were significantly worse in the states with more unequal asset distribution; with correlation coefficients ranging between -0.56 (stunting) and -0.80 (life expectancy). Conflict status predicted worse outcomes. Wealth redistribution in the more unequal states; as well as a political resolution of conflict; may improve population health